Flynn, Lauren Nicole (2020-03). THE EFFICACY OF MI VARNISH VERSUS PRO SEAL SEALANT ON PREVENTION OF WHITE SPOT LESIONS IN ORTHODONTIC PATIENTS: A RANDOMIZED CLINICAL TRIAL. Master's Thesis.
Thesis
Purpose: To compare the efficacy of CPP-ACP MI Varnish and ProSeal sealant in preventing white spot lesion (WSL) formation in orthodontic patients. Materials and Methods: This prospective randomized clinical trial included 40 orthodontic patients between the ages of 12-17 who were randomly allocated to two groups. Group 1 (Sealant Group) received sealant on the maxillary anterior canines, lateral incisors, and central incisors, with reapplication of the sealant every 3 months. Group 2 (Varnish Group) had MI Varnish applied every 4-6 weeks, without sealant placed on the maxillary anterior teeth. White spot lesion formation was evaluated with standardized digital photographs at two timepoints, T1 (initial appointment before bonding), and T2 (12 months later, with brackets removed). The brackets were removed in order to facilitate an adequate photographic exam. Photographs were analyzed side-by-side at the conclusion of the study with the Enamel Decalcification Index (EDI). The location of WSLs were recorded by tooth type and by region. Oral hygiene was evaluated at T1 and T2. Results: At the start of the study (T1), 32.5% of the subjects and 11.3% of the teeth exhibited WSLs. Approximately 42.5% of the subjects and 14.9% of the teeth developed new WSLs during the course of the study. The lateral incisors showed the highest incidences of WSL formation in terms of number of teeth (9.5%), number of subjects (32.5%), and total new EDI scores. The incidence of WSL formation and new EDI scores was significantly greater in the gingival region, than mesial, distal, or incisal regions. The majority of decalcification scores were minor. Out of all decalcification scores (1-3), 88.3% were scores of "1", 6.7% were scores of "2", and 5% were scores of "3". There were no between-group differences for development of WSLs by tooth or by region. Poor oral hygiene at T2 showed a high positive predictive value (76%) for development of WSLs. Conclusions: MI Varnish and ProSeal sealant provide similar protection during fixed orthodontic treatment. Even though the incidence of WSLs is high, the severity of WSLs in patients treated with either sealant or varnish can be minimal. The lateral incisors and the gingival region are more likely to develop new WSLs. Patients who develop WSLs tended to have poorer oral hygiene during treatment.
